The national opioid prescribing rate started increasing in 2006, with the total number of prescriptions dispensed peaking in 2012 at more than 255 million. Ranging from hydrocodone to oxycodone, opioids bind to receptors in the brain to disrupt pain signals, while at the same time activating reward areas in your brain that produce euphoria-inducing dopamine.

The downside of these drugs are that they start to lose effectiveness as your body adapts over time, meaning you need more and more to feel the same effect. That can eventually lead to overdose. In 2017, more than 72,000 people died of drug overdoses — and two-thirds of those were linked to opioids.

Yossuf Albanawi shares that “the opioid crisis is grounded by personal stories,” including his own. As a teenager he struggled with substance abuse but, thanks to his mother, he received an early intervention that led to his recovery and sobriety.

“That’s when I realized that, like any other disease, this is preventable and you can take active measures to ensure that,” he says.

While working at a rehab center, Albanawi saw a lot of patients coming in and walking out with a opioid prescription. “After hearing their stories, I realized that none of their loved ones, family members, or their physicians had any idea until years into their addiction. I was lucky I had a support system early on,” he says.

Albanawi and Gautam Chebrolu co-founded smart pill bottle startup Pilleve to double down on the concept of early intervention and identify those high-risk patients before it becomes an issue.

Pilleve’s pill bottle tracks patient behavior while they’re taking opioids to make sure the prescriptions are taken correctly. The bottle is prescribed by the doctor along with the opioid and, once the prescription is picked up, the patient downloads an accompanying app.

“Patients are incentivized to [input] the pain levels and their mood before dispensing. We get this rich data and we assess that these patients are getting better or getting worse — if they’re increasing their intake, how often, their pain levels, and more,” says Albanawi.

When it’s time to take their pill, the user can go into the app, answer the optional pain level question and then click “I need a pill”.

The Pilleve bottle doesn’t change the workflow of pharmacists, as they simply drop the medication inside as they normally would and locks the top. If the patient tampers with the device, it alerts the physician in real-time.

“All these data points are kept into account and then this data gets relayed back to a physician to potentially intervene,” says Albanawi. “Since pain patients don’t come back to the clinic often, there’s no remote way of identifying that the patient is at risk. That’s the gap we’re addressing.”

Through early pilots, the team shares that, despite making the pain level question optional, patients were completing it often, and slowly becoming more aware of why they were choosing to take a pill. The extra step in the process made them more conscious of their choice and actually decreased the amount of medication they were using.

“It’s almost like an extra security layer between the pills and the patients,” he says. “We want to empower the patients at the end of the day.”

It’s a similar behavior change as that used in money budgeting principles, where individuals who aren’t great with budgeting are told to use only cash, rather than a credit card. Seeing the cash leave your hand often carries more weight than simply swiping a card.

“Compare it to today, where you dump pills on your hand. That behavior does not make you aware of exactly how many pills you’re taking. If you drop a few or take several, you have no idea.”

The physicians receive a daily or weekly patient report with timestamps of when each pill was taken and insights into usage, which is then added to their records. Eventually, the Pilleve team plans to add a tech-enabled platform that integrates with the patient’s electronic record to fit more seamlessly into the workflow of the doctors. They also want to add more resources and educational content to the app for the patients.

The B2B model has two revenue streams. The first one is direct sales of the hardware, which is covered by patients and pharmacies to be reimbursed by insurance companies in the future. It’s a similar setup as the insurance code for a prescribed glucose monitoring device.

The second revenue stream is the software arm, where hospitals and clinics pay a monthly subscription fee per physician for the reporting features. Right now, they’re working with independent pharmacies that are affiliated with hospitals, pain clinics and emergency centers.

Earlier this year, Pilleve closed a $220,000 pre-seed round. They will be getting back to fundraising once again in about six months for a $1.5 million seed round, earmarked for product development and, because of their high touch sales strategy, to increase their sales team.

They have plans to expand to Georgia, Massachusetts, San Francisco and Maryland in the coming months. Pilleve is based in North Carolina with an increasing presence in Washington, D.C. and San Francisco.